Registration 50 KM

P
- Paid
- Pending
Q
- Confirmed
- Pending
M
- Confirmed
- Pending
No
BIB
Reg ID
Take your time to fill in this registration form as accurate as possible
Category
Race Experience
Tell us, at least one race that you have completed. For 170KM, 100KM, 65KM and 42KM, this will determine if you qualify to enter. Our Race Director will review your submission, and only after Approval (and Payment) your participation will be Confirmed.
Race Completed (1):*
Details*
*
*
Result*
Race Completed (2):
Details
Result
Files Upload
Headshot Foto 1/2 Badan*
Accepted file types: jpg, jpeg, png.
Upload your photo here, showing your face clearly. (Format: jpg|jpeg|png)
Passport/KTP Upload*
Accepted file types: pdf, jpg, jpeg, png, gif.
Upload Passport/KTP (Format: pdf|jpg|jpeg|png|gif) IMPORTANT: We need this to apply for National Park Permit | Please Change Format Name KTP_yourID (example : KTP_3311122911950004.jpg)
KITAS Upload
Accepted file types: pdf, jpg, jpeg, png, gif.
Only for KITAS Holder (Format: pdf|jpg|jpeg|png|gif)
Race Result (1)*
Accepted file types: pdf, jpg, jpeg, png, gif.
This is optional. Screenshot or e-certificate of your previous race result. (Format: pdf|jpg|jpeg|png|gif)
Race Result (2)
Accepted file types: pdf, jpg, jpeg, png, gif.
This is optional. Screenshot or e-certificate of your previous race result. (Format: pdf|jpg|jpeg|png|gif)
Personal Information
First Name*
Last Name*
Nationality*
Passport/KTP Number*
Are you KITAS holder?*
- Yes
- No
KITAS Number*
Date of Birth*
Date Format: MM slash DD slash YYYY

format: example: 1985-12-01 for 1 December 1985
Gender*
Blood Type*
Event T-Shirt Size*
Correspondence & Residential Address
Email*

Same email can only be used for one runner
Mobile Number*
Example: +6281212345678, +622198765432 Please include country code and area code (if applicable)
Address Line 1*
Address Line 2
City*
State/Prov*
Country*
Postal Code*
Emergency Contact Name*
In case of emergency, who should we contact?
Emergency Contact Number*
Example: +6281212345678, +622198765432 Please include country code and area code (if applicable)
Origin*
Coupon
Registration Fee IDR
0
Date Format: MM slash DD slash YYYY
Agreement*
- I agree to the Terms of Service
IMPORTANT: This is very challenging trail race. By registering for this event, you have read and agree to the conditions stated in the Terms and Condition, Rules & Regulations.
And you promise to train. Hard.
Payment Category
Payment type
Status
Fee amount

Registration 50 KM

Race Experience

Files Upload

Personal Information

Correspondence & Residential Address